bad taste

in one room at cooper green hospital lies a patient with end-stage renal disease who undergoes dialysis. he is an illegal immigrant to the US, and in light of this fact, no outpatient dialysis centers will take him (because they will not be compensated for his care). he is a quiet, respectful man who speaks good english. without this dialysis 3x a week, toxins will build up in his blood and he will die.

in another room at cooper green hospital, shackled to a bed, lies a woman in her late 20s. a police officer sits in the room. she has a history of iv drug abuse. she developed endocarditis (an infection of a heart valve, a common complication of iv drug abuse) while in jail and was brought to us. this is not her first episode of endocarditis. she is generally respectful and well-mannered. she might receive surgery during this hospitalization to replace the recurrently infective valve, but the surgeons are requiring some type of word that she will quit iv drugs afterwards before they proceed.

although both of these patients are receiving the optimum medical care we can give, the attitude with which some of the doctors approach each of them is embarrassing.

although i have neither the energy nor knowledge to launch into a discussion on illegal immigrants, i know this: it is my duty as a doctor to care for my patients' health. where these patients come from is of no consequence to this duty. i sat in shock this morning as two interns discussed how we should just "put them on a bus back to mexico." if that's your personal philosophy - believe as you like - but leave it at the door when it's time to take care of people. i think what confused me the most was the treatment of the second patient i described. although she has an extensive history of things she could be judged for, no one seemed to judge her. i'm not asking people to judge her, by all means, but i am befuddled.

how is it that we socially condemn a man who has entered our country illegally, probably to get a job and earn money to send back to his family, yet we allow grace to a woman who has made recurrent decisions to use drugs, ending up in jail? is it that we're incredibly selfish, and this man's ingenuity threatens us? i don't know. maybe the fact that the woman is young and white factors in. i have no way of knowing. it just saddens me.

and that's how i feel now: sad. sad that the first patient i described will die somewhere in america, soon, with failed kidneys. sad that my second patient will have her heart valve replaced, subsequently relapse into iv drug use (mean number of relapses before getting clean: 7) and die from complications. and ultimately sad that somewhere along the way some of my colleagues think that they can judge who is worthy of their treatment... with no semblance of common sense being applied to that judgment.

i hope i never lose the sense of moral responsibility i have today. if you're a praying person, that's what you can pray for me through this long journey in becoming a doctor.